第4代达芬奇机器人手术系统在新辅助化疗后中低位直肠癌病人中的临床应用

Clinical efficacy of fourth-generation Da Vinci robotic surgical system for mid-low rectal cancer after neoadjuvant chemotherapy

目的探讨第4代达芬奇机器人手术系统在新辅助化疗后的中低位直肠癌病人中的临床疗效。方法采用回顾性分析研究,收集2020年8月至2023年5月间徐州医科大学附属医院收治的完成术前新辅助化疗的中低位直肠癌101例,采用倾向性评分匹配法(1∶1,卡钳值=0.01),基于性别、年龄、美国麻醉医师协会(ASA)评分、体重指数、肿瘤位置、TNM分期、新辅助治疗,将机器人手术组与腹腔镜组配对,最终入组90例,男性56例,女性34例。45例行第4代达芬奇机器人辅助直肠癌根治术,设为机器人组;45例行腹腔镜辅助直肠癌根治术,设为腹腔镜组。观察指标:围手术期多项临床指标及术后病理学情况。结果机器人组与腹腔镜组比较,术中出血量减少、术后首次进食时间缩短、导尿管拔除时间缩短、术后疼痛程度更轻、淋巴结清扫数目更多,但手术时间更长、住院总费用更高,差异均有统计学意义(均P<0.05)。结论第4代达芬奇机器人手术系统与腹腔镜手术在新辅助化疗后的中低位直肠癌病人中一样安全有效,并且在手术创伤、术后恢复以及肿瘤学根治程度方面存在一定优势。

Objective To assess the clinical efficacy of fourth-generation Da Vinci robotic surgical system for mid-low rectal cancer after neoadjuvant chemotherapy.Methods A retrospective analysis was conducted for collecting the relevant clinical data from 101 patients with mid-low rectal cancer on preoperative neoadjuvant chemotherapy between August 2020 and May 2023.Propensity score matching(1:1,caliper value=0.01)was utilized for pairing propensity scores based upon gender,age,ASA score,body mass index(BMI),tumor location,TNM stage and neoadjuvant therapy.A total of 90 patients were finally enrolled,including 56 males and 34 females.They were assigned into two groups of robot-assisted radical resection of rectal cancer using fourth-generation Da Vinci system(robot,n=45)while laparoscopic-assisted radical resection(laparoscopic,n=45).Observation parameters included perioperative recovery and postoperative pathological conditions.Results As compared to laparoscopic group,robot group exhibited lesser intrpaoerative blood loss,shorter time to first postoperative feeding,quicker removal of urinary catheter,lower postoperative pain intensity and greater number of harvested lymph nodes.However,it had longer operative duration and higher total expense of hospitalization.Conclusion The fourth-generation Da Vinci robotic surgical system is as safe and effective as laparoscopy while potentially offering advantages in terms of surgical trauma reduction,improved postoperative recovery outcomes and oncological radical resection in patients with mid-low rectal cancer after neoadjuvant chemotherapy.